Listen in as we dive deep on the topic of therapy with VIN Foundation Vets4Vets® team member Dr. Michele Gaspar in this Inhale, Exhale podcast series.
In this episode we have 15 major topics we’re addressing:
- Why people reach out for therapy
- Difference between therapy and coaching
- Different types of therapy
- How to find a therapist
- How to pay for therapy
- Determining a good fit
- Therapy frequency
- Red flags
- Confidentiality
- Identifying goals
- Is important for the therapist to have a relevant background to your situation
- Does therapy have a timeline
- How do you terminate therapy
- When is it appropriate to seek psychiatric support
- How do you find a psychiatrist
As always, we want to hear from YOU. Please share your thoughts by sending an email or joining the conversation.
GUEST BIO:
Michele Gaspar, DVM, MA, LCPC
Michele Gaspar is a veterinarian and a psychotherapist. She is a 1994 graduate of the University of Wisconsin School of Veterinary Medicine and received her Master’s in counseling from Loyola University/Chicago in 2012. Michele has worked in a variety of settings in both of her professional careers. As a veterinarian, she has had experience in general practice, emergency and critical care, shelter medicine and feline-exclusive medicine. As a therapist, she has worked in community mental health, group psychotherapy practices, hospital chaplaincy and now owns a private psychotherapy practice in Chicago. Michele is a consultant in Feline Internal Medicine on the Veterinary Information Network (VIN), where she also co-facilitates the NAVLE Review Workshop and offers webinars to veterinarians on psychosocial issues that impact veterinary clinical practice. As a member of the VIN Foundation’s Vets4Vets® team, she facilitates an annual mindfulness retreat for veterinarians each Fall and consults with veterinary colleagues and students who wish to access local mental health resources. She is an advanced candidate at the Chicago Center for Psychoanalysis and is a Fellow of the American Balint Society.
LINKS AND INFORMATION:
Find A Therapist/Psychology Today
What is Psychodynamic Therapy?
VIN Foundation Connect with Vets4Vets®
VIN Foundation GIVE page to support these programs & tools
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TRANSCRIPT
Intro
Michele Gaspar, DVM, MA, LCPC: Most anyone can benefit at some point in their lives with some type of therapy. Note how I’ve qualified it. But I think for most of us, we’ve wrestled with things that have either been normalized or we’ve chosen not to confront. And particularly for the latter, they do catch up with us.
Jordan Benshea: That is VIN Foundation’s Vets4Vets® team member and veterinarian, Dr. Michele Gaspar. And this is the VIN Foundation’s Veterinary Pulse podcast special Inhale, Exhale series. I’m Jordan Benshea, Executive Director of the VIN Foundation. Join me as I talk with veterinary colleagues about critical topics and share stories that connect us as humans, as animals, as a veterinary community. This podcast is made possible by individuals like you who donate to the VIN Foundation. If you enjoy this podcast and want to hear more stories, you may support these efforts with a donation at VINFoundation.org/give. Thank you. Please check the episode notes for bios, links, and information mentioned. Welcome, everyone. I’m very excited to have you here for this episode of the VIN Foundation’s Veterinary Pulse podcast, Inhale Exhale series. And this episode, we are with Dr. Michele Gaspar, who is one of our VIN Foundation Vets4Vets® team members, and we are talking all things therapy. Welcome, Michele.
Michele Gaspar, DVM, MA, LCPC: It’s great to be here, Jordan. Thanks for having me.
Overview
Jordan Benshea: Thank you for being here. We get so many questions about therapy, and through our Vets4Vets® Confidential Wellness support programs, we’ve had so many colleagues reaching out wanting to know how to find a good therapist, trying to understand what therapy is, at what point do they need it, how does it work. And so there’s a lot of myths and preconceptions, and so we thought let’s dive in with this episode and answer some questions, and learn more about finding a good therapist and hopefully finding someone that’s a good fit. We have 15 topics that we’re going to be addressing today, so it’s a big one. But hang in there with us, and we’re going to go through them. So number one is why people reach out for therapy. Number two is the difference between therapy and coaching. We hear a lot about the word coaching lately in the wellness space. Number three is different types of therapy. Number four is how to find a therapist. Number five is how to pay for therapy, which is a big topic as well. Number six, determining if it’s a good fit, because sometimes it’s not. I’ve had many that are not the right fit. Number seven is therapy frequency. How often should you be going? For what sort of situation? Number eight is red flags. if you’re feeling some red flags in a therapy session, what are they? What should you look out for? Number nine is confidentiality. Number ten is identifying goals for your therapy sessions. What does that look like? Eleven, is it important for the therapist to have a relevant background relevant to your situation? We see a lot of veterinarians reaching out to other veterinary specialists in therapy. Number twelve is, does therapy have a timeline? Some people might think of therapy as this is just I’m going in and we never have any idea when I’m coming out, so we’ll discuss that. Number thirteen is, how do you terminate therapy? Is there a time for that? What does that look like? Number fourteen is, when is it appropriate to seek psychiatric support? And number fifteen is, how do you find a psychiatrist? So we will go through all of that, and it’s a lot, and let’s just dive right in.
Why Seek Therapy
Jordan Benshea: So what are the reasons you hear colleagues are looking for therapy?
Michele Gaspar, DVM, MA, LCPC: Well, typically people reach out to Vets4Vets® and talk to Bree Montana, who is really our leader in the Vets4Vets® team. And Bree does a very, very good job as far as assessing what the issues are. If she thinks that what she’s hearing are either longstanding patterns, acute situations, so for example veterinary students or veterinary clinicians might have exacerbations of anxiety or depression. If she hears that the individual is already in therapy, things aren’t working, she will refer to me. And my job is not to provide therapy, but to provide some type of scaffolding and some type of template. So people are going because they continually find themselves in the same patterns. They keep choosing jobs that are not good fits. They consistently bump up against issues with staff or clients. They might have also interrelational problems with their partners, with family members. They may be dealing with the illnesses of close friends, close family members, partners, parents. So all those things. Some people reach out because they have had a beloved companion animal pass away and they are really in protracted grief. So those are some of the big issues that people bring when they come and talk to me.
Therapy vs Coaching
Jordan Benshea: One term we’re hearing a lot of these days in the wellness space is wellness coaching. So can you help us understand, is there a difference between therapy and coaching? Are they just the same? Does it matter? If you can help our audience understand some of that insight, I think that’d be helpful.
Michele Gaspar, DVM, MA, LCPC: Sure, sure. There are actually pretty significant differences between coaching and therapy. Many therapists will provide some degree of advice or some suggestions. That’s really not the realm of therapy. I’ll get to that in a minute. But I think the biggest difference is coaching assumes a position of mental wellness, and it’s also future-directed. So with coaching, you’re coming with a goal. For example, I’d like to be medical director in my corporation. So what a coach might do is they might suggest how to develop leadership skills, how to develop better communication skills, how to boost one’s interpersonal skills. Those things to get to a goal. A therapist might be more interested in why assuming a medical directorship is important to you. Is there a type of achievement that might have been suggested by your parents, for example. So are you the kind of person that always has to move forward and has to achieve more and more and more? So those are the differences. I would say the biggest thing is that coaching is future-directed. Therapy looks at our past and our present.
Jordan Benshea: I think that’s a very good description, and I appreciate those examples for our audience because sometimes it’s just so hard to untangle that, especially with the amount of content that we see around wellness.
Types of Therapy
Jordan Benshea: So what are the different types of therapy?
Michele Gaspar, DVM, MA, LCPC: Well, in contemporary psychotherapy parlance, we’re in the world of acronyms now. We’re certainly in the age of acronyms.
Jordan Benshea: And so we will make sure to put all these acronyms in episode notes along with links.
Michele Gaspar, DVM, MA, LCPC: Absolutely.
Jordan Benshea: Yes.
Michele Gaspar, DVM, MA, LCPC: Absolutely. So, we have acceptance and commitment therapy, ACT therapy. And that’s a very pragmatic type of therapy where just as it says, we accept the situation. Many times our suffering is caused by the fact that we’re trying to move the needle on things that are unmovable. Now, understanding how much control we have is pretty important. So with acceptance commitment therapy, we accept a situation and we commit to work with it as it presents itself. A very common type of therapy now, and one that I hear a lot of veterinarians use because we tend to be very pragmatic people and we want a quick fix, is cognitive behavioral therapy. Cognitive behavioral therapy essentially presumes that if we can change the way we think about something our behaviors can change as well. It’s typically short-term therapy. It certainly does work. It’s evidence based, but it’s not the type of therapy that I practice. My concern with cognitive behavioral therapy is that it definitely relieves the symptom, but as I explain to my veterinary colleagues, it’s like if you have a patient come in with a bleeding area. You can put a Band-Aid on it, and the Band-Aid should control the bleeding, but ultimately you got to go in and you have to find the bleeder. You have to find that vessel that’s leaking. And so cognitive behavioral therapy works in the short term, but it doesn’t get to underlying issues. Another very common type of therapy is dialectical behavioral therapy, DBT. That was actually brought to the fore by Marsha Linehan. It is used primarily to work with highly reactive people, particularly people on the borderline personality disorder spectrum. It uses acceptance. It uses mindfulness. It decreases reactivity and gives resources and skills in order to do that. The oldest form of psychotherapy, which is the therapeutic model that I use in my practice, is psychodynamic or psychoanalytic. Psychoanalysis, of course, started with Sigmund Freud in the late nineteenth century. Freud had a lot of blind spots. I tend to look at him as a man who lived in late nineteenth century Vienna with a very specific patient population. He certainly was a physician but did not have access to what we have today. But Freud said that patterns will persist until the antecedents are identified and worked through. So with a psychodynamic or psychoanalytic practice, one looks at the past, childhood, adolescence, family of origin, and it recognizes that the situations we find ourselves in are longstanding patterns that we can trace back. We’re not constantly looking backward because I don’t think that would be helpful. And we’re not rewinding the wheel to five years of age, for example. But it’s less about what’s in front of us and more about the present and the past. There are others, solution-focused therapy, all manner of things, mindfulness-based therapy, but I think those are the four that are most applicable to current US, North American, even Western Europe psychotherapy to date.
Finding a Therapist
Jordan Benshea: Okay, and if colleagues are listening and think, “I would really like to find a therapist,” where do they start? What does that process look like?
Michele Gaspar, DVM, MA, LCPC: You certainly can check with friends, but I think the best resource, at least in North America, is finding a therapist on Psychology Today. So Psychology Today has a wonderful website where you can check out therapists, licensed counselors, licensed clinical social workers, clinical psychologists by zip code, by city, by insurance that’s accepted, and also their focus. And it is a question of probably how many frogs do you need to kiss before you find the right one? So when I suggest therapists to colleagues who call through Vets4Vets®, I usually give them five. I said, “talk to everyone. It’s like a dating app. There’s a picture, somebody says a little something about them, but you really do need to talk to somebody either on the phone or face-to-face. You’re really looking for the feel. Do you feel you can work with this person?” So Psychology Today, I think would be number one. If you are either under the care of a primary care physician or a psychiatrist, oftentimes they have providers who they refer to. And so those would be the two main ways of finding your future therapist.
Jordan Benshea: And how about outside of the US, in Canada or Europe?
Michele Gaspar, DVM, MA, LCPC: Psychology Today works for Canada. So that would be helpful. In Western Europe what you can do is you can check with, for example, in Italy, Italian Psychological Association will have a list. In the UK there are a number of psychological services. The UK is a little different because NHS has a very robust behavioral health segment. So oftentimes through NHS there will be referrals there. And the same is true, France has had a very robust psychotherapy community for a very, very long time, well over 100 years. And so oftentimes those types of bodies are the best.
Jordan Benshea: Okay.
Paying for Therapy
Jordan Benshea: One hurdle that we hear a lot of times is how colleagues can pay for therapy. I think that’s a big hurdle that-
Michele Gaspar, DVM, MA, LCPC: Yeah
Jordan Benshea: … that is sort of a barrier for many. What recommendations do you have for colleagues around that?
Michele Gaspar, DVM, MA, LCPC: It certainly can be a very significant barrier to therapy. One of the things that I like about the Psychology Today website is you can actually filter for your insurance. If there is no provider in your area who accepts your insurance, then you still have some options. The first is out of pocket, and that can get very, very costly very quickly. The second is to look for community mental health organizations that oftentimes will have sliding scale fees. Oftentimes private practitioners will have sliding scale. I see some of my clients have got sliding scale because of their financial situation. Sometimes by getting someone who’s an early career professional, so might not be fully licensed, clinically licensed they will also offer a lower cost. So it’s going to take a little extra investigating, but I do think that in most medium to large size cities in North America, and certainly I think in Western Europe as well, in the UK, you should be able to find someone who you believe you can work with and they will see you for a reasonable cost.
Jordan Benshea: Okay, those are some good tips.
Fit and Early Red Flags
Jordan Benshea: So you mentioned earlier kiss many frogs. How does somebody know if a therapist is a good fit for their situation?
Michele Gaspar, DVM, MA, LCPC: I would avoid someone whose profile says that they can treat many, many, many different things. I think as in veterinary medicine and as in psychotherapy, we have to have a very clear idea of what our capacity is, and to have the humility to say, “there are some types of people I’m simply not trained to see.” So the first red flag would be somebody who can see everyone. I think the second red flag, particularly in a initial consultation, so most therapists will give a 15 to 30-minute free consultation kind of like a meet and greet. Oftentimes having a veterinarian as a psychotherapy client is kind of cool, but you want to also listen, particularly if you’re a veterinary clinician, you want to listen for how interested is the therapist in the career, in the profession. I often hear that sometimes psychotherapy sessions for our colleagues have kind of degenerated into conversations about the therapist’s own pet-
Jordan Benshea: I had a feeling you were going there.
Michele Gaspar, DVM, MA, LCPC: …Or asking for medical advice, and that’s not part of the therapeutic alliance and the responsibility the therapist has to the client. So I would be listening for that. I also would be interested and would kind of use this as a red flag, of course anything that would guarantee some type of relief of symptoms. A therapist who would either say something about a protracted treatment course or a very truncated treatment course. A therapist who uses multiple ideologies or theories. That is not to say that we can’t use information from many systems, but there has to be some type of foundation upon which the treatment is based. And then we’re listening for warmth. We’re listening for the therapist’s ability to listen while we’re talking. So not talking over us, not asking too many questions, you know, 20 questions kind of thing. Those to me would be the big ones.
How Often to Go
Jordan Benshea: Okay, and how often should someone see a therapist?
Michele Gaspar, DVM, MA, LCPC: Ideally, and I think this is pretty standard, pardon me, once weekly at least for the first six to twelve months of treatment is really pretty standard. I hear a lot of people who want to go every two weeks or every month, that’s not therapy because what happens is the longer that you increase the length between sessions, the sessions become narratives of activity. So on Monday I did this, then last Saturday I did this, and that’s really not therapy. That’s a report of activities. It takes about three months of weekly therapy to form what we consider to be a therapeutic alliance, and that means the therapist is comfortable, the client is comfortable, and you’ve got a working partnership going. So anything that increases length between sessions really does not serve the alliance and typically doesn’t serve treatment.
Jordan Benshea: Those are some good tips. Yeah, having that sort of timeline in the mind can be really helpful. It’s not a one-week, two-week situation.
Michele Gaspar, DVM, MA, LCPC: Yes, yes.
Jordan Benshea: It’s more of a commitment.
Michele Gaspar, DVM, MA, LCPC: Yes.
Confidentiality and Boundaries
Jordan Benshea: Obviously the patient-therapist relationship is a confidential one. You mentioned a couple red flags. Can we dig a little deeper on that and talk about what sort of red flags colleagues might look for, or if they hear something when they’re in a therapy session, what would those red flags be that would be sort of the sign of this isn’t a good fit, you might be headed in not a great direction?
Michele Gaspar, DVM, MA, LCPC: I think this leads us to two questions. What is confidential? And then, what can be self-disclosed from the therapist’s standpoint in therapy? What we don’t want is we don’t want a therapeutic session to then become about the therapist. That’s important. The goal, the focus has got to be on the client. So as far as confidentiality, the only thing that would break confidentiality, and by that I mean normally anything that is said in a therapy session is considered to be confidential, unless there is an issue of threat of self-harm or threat of harm to others, so suicidal ideation, homicidal ideation. If the client discloses that they know about some type of abuse, child abuse, elder abuse, even in some cases and in some municipalities, some jurisdictions, animal abuse. Therapists are mandated reporters, and so that keeps the frame and it protects the client from harm. So those are the things that can’t be shared. Not too long ago there was a huge pushback against self-disclosure by therapists. So the therapist was considered to be a blank slate. You knew nothing about them, and that served the therapy. That’s been relaxed somewhat, and particularly over time we can learn about the therapist’s partner, that they have children, that they have a pet. We can learn all those kinds of things. But when the therapists are self-disclosing issues that they’ve struggled with in an attempt perhaps to appear empathic, share things that they’re going through, that definitely is a red flag. What I tell people is, “If you are uncomfortable, listen to that.”
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: That’s your best gauge as to whether or not things are going off the rail or not.
Jordan Benshea: I one time had a therapist who I was sharing something about a family member, and they asked the family member’s name.
Michele Gaspar, DVM, MA, LCPC: Yeah.
Jordan Benshea: And that to me was just the huge gut check, red flag that I thought, “this is not right. It doesn’t matter.” So I think going with your gut is always very helpful.
Setting Therapy Goals
Jordan Benshea: Should therapy sessions have specific goals? I know that we talk about goals in a lot of different ways in our lives. Does that apply to therapy as well?
Michele Gaspar, DVM, MA, LCPC: Well, I think we’re talking about two different things. We’re talking about a life goal and we’re also talking about a therapeutic goal, and they’re very, very different. So most people will come to therapy, perhaps they have a problem with their relationship, they have a work-related issue, they’re thinking about going back to school, they’re thinking about having a child. Those are life goals. What a therapist does is internally take those life goals and formulates what we call a therapeutic issue. So for example, there might be a breakdown in a relationship because the client in front of us always gets into the same situation. Perhaps they always choose a partner with substance abuse issues, and it’s a repeated pattern. So there’s the goal of strengthening the relationship that the client comes with. Our job as therapists is to try to make sense of the pattern. So I think that’s very important. Therapy should always have a goal, and the goal should be reevaluated periodically. So it’s not a question so much of are you cured, but do you feel that you have the skills and the resources necessary to take what we’ve done and use it on your own. It’s not a question of an interminable psychotherapeutic treatment. And so I think the ultimate goal of therapy is that we learn something about ourselves. We learn about those antecedents, what it meant to be us in a particular family, and to be able to move forward with that knowledge and those skills.
Jordan Benshea: That’s a great way to describe it. Yeah. I think that’s very helpful.
Does Background Matter
Jordan Benshea: With the VIN Foundation Vets4Vets® program, we find many colleagues appreciate the peer support from someone who understands the in and out of vet med, and in some cases we’ve learned that it helps them sort of leapfrog months because somebody goes in understanding that education of that background, what is it like, what’s the day-to-day, what sort of normal pressures, et cetera. How important is it do you feel, or is it important do you feel for the therapist to be well-versed in the area that the colleague’s seeking help for?
Michele Gaspar, DVM, MA, LCPC: I don’t think it’s necessary at all. I see a variety of clients, mostly physicians throughout the years of training, but I also see people in IT. I see people in law. I see people in business.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: I see public school teachers. I think as veterinarians, and this is not to say we don’t have a very special role, but our issues are really no different than the issues that other people have. The environments of all these people are very, very different. I don’t have to be in a classroom to understand what a pre-K teacher in a public school is going through. But I do understand the stress of a leadership that is not responsive. I understand how it is not to have the support of parents. I understand to be overwhelmed because we simply don’t have support. Those are therapeutic issues, and whether they take place in a pre-K classroom or an attorney who is having anxiety about litigation, a particular litigation that they’re involved in, it really doesn’t matter. And I hear this too, Jordan, a lot, they just don’t understand veterinary medicine.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: To be a good therapist, and it would be impossible, it would be impossible to, for example, that would mean, so if you needed a veterinarian only to understand veterinary medicine, then the only therapist you could see if you were an attorney, you’d have to see one that had a JD. If you were in IT, you would have to see someone who had experience in software architecture, and so it’s not that important.
Jordan Benshea: Okay.
Michele Gaspar, DVM, MA, LCPC: And I will tell you, that’s a bubble that I often have to burst.
Jordan Benshea: Yeah. No, I think that, I wonder if maybe the peer support is just a different aspect of it that we hear when they’re just looking for that additional peer support because, I mean, obviously we say Vets4Vets® is not in lieu of therapy in any way, but I think that probably to your point, if you’re finding a therapist that’s a good fit and they are practicing a specific type of therapy that’s recognizing the patterns, those patterns transcend the profession.
Michele Gaspar, DVM, MA, LCPC: Yes. I mean, I see people who are non-binary. I see people who are trans. I see gay and lesbian people. I see heterosexual cisgender people. I don’t have to inhabit those identities in order to be of help to them.
Jordan Benshea: Right. Right.
Timeline and Ending Therapy
Jordan Benshea: If we have some listeners that might be thinking, “okay, this makes me feel a little bit more comfortable reaching out for therapy,” and might be interested in starting therapy, but might wonder, “how long does the process take? What is the timeline?” We’ve mentioned earlier in the episode, we talked about that it can take up to three months to really form that partnership. Are there other timelines associated with therapy that you think are important?
Michele Gaspar, DVM, MA, LCPC: Oh, once again, I think it depends on the issues that are brought. It also is up to the client to decide if they’ve gone far enough to their satisfaction. For example, I saw a woman weekly for eighteen months. There was a family, as we would say, a family of origin issue with siblings and parents. There was a lot of chaos in that household growing up. There was substance abuse issues. And the client came with some very specific goals around boundary setting with siblings who were substance users, and there was plenty there. There was plenty there after eighteen months, and she came to me and she said, “this has been really helpful. I’ve developed the ability to say no.” I mean, she was letting these people basically take advantage of her, and she said, “I know there are other things here, but for now, this is what I need to move forward.” And I think that was a reasonable end of treatment. I have had clients come with very significant sexual trauma as children. That’s going to usually be a very protracted treatment course simply because you can’t dive in. And so it really depends on the issue and when one thinks they’ve done enough.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: And that’s a conversation that needs to be had so that we don’t terminate with a text message or an email or just ghost. Clients do not treat their therapists any differently than they treat other people in their lives. It’s a relationship, and so the best is to have a very honest relationship so that when the client feels it’s been enough you can talk about it and you can agree or not.
Jordan Benshea: Or not.
Michele Gaspar, DVM, MA, LCPC: Yeah, but I never say, “oh no, there’s plenty here.” Nothing like that.
Jordan Benshea: I think that leads perfectly into our next topic about, as with many things in life, relationships run course. Other things can run their course. How does someone terminate therapy? And I think you sort of just teased that a bit of like it’s just like your patient had done, I think this is what’s helpful for me right now. I’ve got these skills that I can take this out. At another point I might dig a little deeper, but for now this has been helpful. Are there other-
Michele Gaspar, DVM, MA, LCPC: Yes.
Jordan Benshea: …links to that? Yeah.
Michele Gaspar, DVM, MA, LCPC: Well, and that’s very different. And this is why I think a psychodynamic, psychoanalytic approach is more helpful, and typically they have longer treatments. CBT, ACT, DBT tend to be more template protocol-focused, so they have a shorter duration. It’s important to have an open relationship conversationally with your therapist so that you’re not leaving therapy because you’re hitting something that’s very difficult. So oftentimes, and I’ve certainly had this, where clients are talking about things that they or realizing things that they may not have had insight into forever and things are starting to heat up and things are starting to get scary.
Jordan Benshea: Uncomfortable.
Michele Gaspar, DVM, MA, LCPC: And the tendency is, “I don’t want to go there. This is not feeling good. I’m out.” And that’s a very tricky situation to navigate, to make sure that we’re leaving for good reason and not that the therapy is uncovering things that we really do need to work on. And so that’s kind of a tricky place to be.
Jordan Benshea: Yeah. That’s a really good reference point, and I mean, in general obviously we hear so much about getting comfortable in the uncomfortable, and when some things get uncomfortable some people might think, “oh, this is just a bit,” yeah.
Michele Gaspar, DVM, MA, LCPC: Right, and we all don’t want to go there. I mean, that’s pretty normal. Who wants to not feel terrific?
Jordan Benshea: I pay to do it, yeah.
Michele Gaspar, DVM, MA, LCPC: But therapy doesn’t necessarily make us feel great all the time, and it shouldn’t be a fan club, you know, “you’re doing great.” There’s a compassionate way to challenge people.
Jordan Benshea: Yeah. That could be very beneficial. Yeah.
When to See Psychiatry
Jordan Benshea: What if a colleague might need a deeper bench of support? When is it time to seek out psychiatric support?
Michele Gaspar, DVM, MA, LCPC: I will tell you that something, Jordan, that I hear quite a bit is our colleagues are fairly reluctant to start medication. Oftentimes in my conversations with them I’ll ask about whether there’s any type of medication management, if they’re seeing a psychiatrist, and I might also suggest that what I’m hearing is anxiety and depression that might benefit from at least a consultation. I think that oftentimes if the anxiety is so high, if the depression is so low, you can’t engage in therapy.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: And so it’s a question of are my symptoms chronic? Are they interfering with my ability to function? So for example, and this is a hard question to ask ourselves, am I self-medicating with alcohol, with food, with sex, with exercise? All these things that can be ways of self-medicating. Maybe we’ve had, and I see this in my own practice and I certainly don’t have medication holster, but I do recommend medication management consult for some clients. Oftentimes we have had very poor experiences before with medication. We’ve had side effects. We haven’t felt that they were helpful to us, the medications. And I understand that. Fortunately, I think psychiatry, certainly 21st-century psychiatry, is well beyond Prozac for everyone. And I think a very thoughtful psychiatrist is going to listen to us. They’re not going to have a prescription pad after 20 minutes and give you an Rx. But I would ask, how significant is the dysfunction at work and at home? And the best combination would be psychotherapy and, if you need it, medication on top of it. There’s a lot being talked about now about what’s called de-prescribing. And so it used to be, and this is what we talked about with therapy just a few moments ago, years of interminable therapy. Now there is within psychiatry a pretty interesting movement that says, “as all medications, we should be trying to revisit medications,” and it might not be that this particular patient needs long-term medication. But that’s something, oftentimes psychotropic medications are actually dangerous to cold turkey. You don’t want to do this on your own and you want to have good psychiatric support. Most therapists work with several psychiatrists that they can refer to. Oftentimes I like to suggest that people contact the psychiatry department of a local medical school or teaching hospital and try to get referrals there.
Jordan Benshea: Okay, so that also covers our next topic, the how do you find a good psychiatric doctor.
Michele Gaspar, DVM, MA, LCPC: And I mean, you should have the same criteria for choosing a good psychiatrist as you do a good therapist.
Jordan Benshea: Okay.
Michele Gaspar, DVM, MA, LCPC: You should have an alliance. You should feel comfortable with this person. He or she should not be judging. They shouldn’t be rolling their eyes. And most psychiatrists now, the days of the 20-minute med management appointment are pretty much going by the wayside.
Jordan Benshea: Okay.
Michele Gaspar, DVM, MA, LCPC: Certainly more psychiatric residencies are incorporating psychotherapy. That kind of fell out of vogue, because for a long time a psychiatrist didn’t have many medications to choose from. So I think in order to make themselves seem more legitimate they kinda got on the medical model. And now I think everybody is seeing that there’s a medical model that’s valid. There’s also a therapeutic model that’s valid as well.
Jordan Benshea: Well, Michele, this has been so helpful and we’ve covered 15 topics, along with more I think. Is there other information you think our colleagues should know about or that you feel we should cover?
Shame Guilt and Mindset
Michele Gaspar, DVM, MA, LCPC: Yeah, I think the shame and the guilt that can definitely rise when someone is looking to begin therapy or certainly when one is considering medication.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: A lot depends on how we see mental illness. This kinda goes back to when I talk to clients and talk to colleagues who are reluctant, particularly colleagues who are reluctant to consider medication. And oftentimes I will ask, “how do you treat separation anxiety in dogs and cats?” Well, they’re given a behavioral med. They might be referring to a trainer, a therapist, but they’re also using a medication to decrease symptoms. Sometimes that lands, sometimes it doesn’t. But I think there’s shame and guilt that many people feel, and a lot depends on our own history of knowing someone who has struggled with mental health challenges, how our families saw people with mental health challenges. That oftentimes gives us a very poor model if those people were subjects of derision or shame or they were dangerous. So I would try to open any conversation with an open mind.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: The other thing is that a lot of our issues have been there for decades. And so we’re fixers. Veterinarians are fixers, and we want a diagnosis, we want a drug, and we want a response. And much like our companion animal patients, our large animal patients who oftentimes do not read the book, people do not read the book either. And I think one of the frustrations about medication management and psychotropic medications is that oftentimes it’s trial and error and it gets very frustrating, and that’s why you want to access the best level of care that you possibly can. And you want somebody who’s in the trench with you, somebody who’s really supportive. And so that’s that. I think that most anyone can benefit at some point in their lives with some type of therapy. Note how I’ve qualified it, but I think for most of us, we’ve wrestled with things that have either been normalized or we’ve chosen not to confront, and particularly for the latter, they do catch up with us.
Jordan Benshea: Yeah.
Michele Gaspar, DVM, MA, LCPC: Later, sooner, they all catch up with us. And therapy is not about support. It’s not having someone to talk to. It’s much richer and much deeper than that. I mean, your friends can talk to you. Your friends can even empathize with you, but a therapist is there not only to accompany you, but to help you develop a self-knowledge that increases your personal strength, your resilience, your self-compassion, all those things.
Outro
Jordan Benshea: Yeah. Well, Michele you are a wealth of knowledge and I really, really appreciate you taking your time-
Michele Gaspar, DVM, MA, LCPC: Well, thank you.
Jordan Benshea: … And your effort in sharing this with our listeners. I think it’s going to be hopefully very helpful to a lot of colleagues.
Michele Gaspar, DVM, MA, LCPC: I hope it is. I hope it is helpful because I came to this work as a psychotherapist in talking to colleagues and realizing that there was a lot of suffering. As all healthcare providers, we’re under tremendous stress, and the stresses are not going to go away. As a matter of fact, they’re going to increase. Our patients are sicker. Our clients require more of us. There are fewer financial resources to go around oftentimes. We’re being pushed to 20-minute appointments, all those things. And depending on how we were reared, we might think that just bucking up, just pushing on, and I think veterinarians have this kinda can-do attitude. Accessing therapy does not mean you can’t do. It’s that you want to be able to continue to do the work, and I think what good psychotherapy does and what good medication management, if necessary, does is it helps to make the career sustainable over time.
Jordan Benshea: And it’s a career that so many people really love, so I want to encourage that. Thank you so much, Michele. I really appreciate all of your time-
Michele Gaspar, DVM, MA, LCPC: Thanks, Jordan.
Jordan Benshea: … And effort-
Michele Gaspar, DVM, MA, LCPC: Thank you.
Jordan Benshea: … And everything that you’re doing to support our colleagues. Thank you. Thank you.
Michele Gaspar, DVM, MA, LCPC: It’s a privilege and a pleasure. Thank you so much.
Jordan Benshea: Thank you.
Michele Gaspar, DVM, MA, LCPC: Take care.
Jordan Benshea: Thank you for joining us for this episode of the Veterinary Pulse. Please check the episode notes for additional information referenced in the podcast. If you enjoyed this podcast, please follow, subscribe, and share a review. We welcome feedback and hope you will tune in again. You can find out more about the VIN Foundation through our website, VINFoundation.org, and our social media channels. Thank you for being here. Be well.